Wednesday, April 10, 2013

With the quiet release of a letter
that will save lives across the state, California
has made it clear that insurance plans are no longer allowed to arbitrarily
deny medically necessary care to any patient simply because they are
transgender.

Yesterday, California's
Department of Managed Health Care (DMHC) clarified the obligations of California's health plans under the Insurance Gender
Nondiscrimination Act. In a directive to health plans, DMHC confirmed that all
people have the right to access medically necessary care regardless of their
gender identity or gender expression. Any treatment that a health plan allows
generally also has to be allowed for transgender individuals. Health plans are
no longer allowed to exclude coverage of "transsexual surgery" or
"transgender or gender dysphoria conditions." Additionally, if
transgender people are denied care they have the right to appeal to DMHC's
Independent Medical Review process.

Combined with a similar ruling
from the CA Department of Insurance in 2012, this means that no California insurance plan can deny people care simply
because they are transgender. With up to 15% of transgender patients denied gender-specific
care such as pap smears or prostate exams, this is a major victory that will
improve the lives and health of transgender people and communities throughout California. These directives constitute a major step
toward equal access to health care.

If you have questions about this
announcement, or other questions about health coverage in and HMO or PPO regulated
by DMHC, you can contact their HelpCenter at 888-466-2219 or
www.HealthHelp.ca.gov.